1. Field of the Invention
The present invention relates to the field of surgery and, in particular, to a method and suture-button construct for stabilization of a cranial cruciate ligament deficient stifle in mammals, in particular, canines.
2. Description of the Related Art
Cranial cruciate ligament (CCL) rupture is the tearing of a ligament in the stifle joint (knee) in canines, resulting in partial or complete joint instability, pain, and lameness. Referring to FIG. 1, the femur 1, tibia 2 and fibula 3 (FIG. 2) meet to form the stifle joint. Ligaments, tendons, and muscles hold the bones in place, stabilize the joint, and enable movement. Articular cartilage attaches to and covers the ends of bones, protecting and cushioning them. A joint capsule, filled with lubricating synovial fluid, surrounds the entire joint.
Referring to FIGS. 1-2, four major ligaments support and stabilize the stifle joint by connecting the femur 1 to the tibia 2 and fibula 3, and the joint capsule to the bones—medial and lateral collateral ligaments 8; caudal and cranial cruciate ligaments 4, 5. The medial and lateral collateral ligaments 8 are located outside the joint. The medial collateral ligament runs from the medial femur 1 to tibia 2. The lateral collateral ligament runs from the lateral femur 1 to head of fibula, passing over the tendon of origin of the popliteus muscle. The medial and lateral collateral ligaments 8 attach to the femur 1 behind the axis of rotation of the femoral condyles and therefore are tensed by extension of the joint.
The caudal and cranial cruciate ligaments 4, 5 are intraarticular ligaments which extend between articular surfaces of femur 1 and tibia 2 and cross one another within the intercondylar notch of the femur. The cranial cruciate ligament 5 attaches to the femur 1, runs across the stifle joint, and attaches to the tibia 2 in a cranial direction (i.e., anterior). The cranial cruciate ligament 5 holds the tibia 2 in place and prevents internal rotation, hyperextension, and cranial translocation of the tibia 2. The caudal cruciate ligament 4 attaches to the femur 1, runs across the stifle joint, and attaches to the tibia 2 in a caudal direction (i.e., posterior). The menisci 6, 7, medial and lateral fibrocartilages located between the femur 1 and the tibia 2, absorbs impact and provides a congruent gliding surface between the femur 1 and tibial 2 plateau.
Cranial cruciate ligament rupture is one of the most common orthopedic injuries in canines and is one of the most common causes of degenerative joint disease in the stifle joint. Chronic or acute rupture of the cranial cruciate ligament consistently results in lameness. Stifle stabilization procedures to address cranial cruciate ligament insufficiency are becoming increasingly important due, at least in part, to increasing pet care awareness.
The goal of treatment is, therefore, to reduce pain and increase mobility of the canine. Multiple surgical procedures—extracapsular imbrication technique, tibial plateau leveling osteotomy and fibular head transposition—are currently available as a form of treatment.
There is a need for an improved surgical procedure for stabilization of a cranial cruciate ligament deficient stifle that is simple, flexible, provides increased strength, and may be performed by a minimally invasive approach, with placement of buttons over the tibia and the femur and secured by a suture-button construct across the stifle joint.